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From The Editor's Desk: A Focus on Cancer Services.
Authors: Amedee RG PMID: 29230106 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

From the Guest Editor: The Rapidly Changing Field of Cancer Treatment.
Authors: Ramirez RA PMID: 29230107 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Ertapenem-Induced Acute Pancreatitis in a Cirrhotic Patient.
Authors: Oztas E, Akpinar MY, Kaplan M PMID: 29230108 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Reply to Polio Eradication in Pakistan: Call for Alliance.
Authors: Ullah MA, Husseni AM PMID: 29230109 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Management of Aortic Root Thrombosis After Implantation of a Continuous-Flow Left Ventricular Assist Device: A Real Conundrum.
Authors: Gulotta J, Morin DP, Krim SR PMID: 29230110 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter To The Editor: Catheter Track Metastasis With Indwelling Pleural Catheter.
Authors: Zank S, Abboud E, Jaber W, Alraiyes AH PMID: 29230111 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Images: Transjugular Intrahepatic Portosystemic Shunt Reduction for Management of Recurrent Hepatic Encephalopathy.
Authors: Khalili H, Goldman D, Frischhertz S, Kirsch D PMID: 29230112 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Bioethics In Practice: Understanding Understood Consent.
Authors: Vasquez RJ PMID: 29230113 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Building a Phase 1 Cancer Research Program: Lessons Learned and Progress Made.
Authors: Matrana MR, Cook J PMID: 29230114 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Interval Colorectal Cancers at Ochsner Medical Center: Where Do We Stand?
Authors: Humphrey F, Gastañaduy M, Smith J, Whitlow CB Abstract Background: An interval colorectal cancer is a cancer diagnosed prior to the recommended follow-up time from a previously negative colonoscopy. These cancers are thought to arise from a rapidly growing cancer, missed cancer, or incompletely resected adenomas. Our study aimed to identify interval cancers diagnosed during a 4-year period and to identify any potential risk factors associated with these cancers. Secondly, we compared our interval colorectal cancer rate with other published rates. Methods: Our population included all patients who...
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Overall Survival Associated With Ileostomy Closure in Patients With Rectal Cancer Before and After Adjuvant Therapy.
Conclusion: Long-term survival was similar in patients who underwent ileostomy closure before and after adjuvant therapy following low anterior resection for rectal cancer. While this study was underpowered, it adds additional insight to an area of surgery lacking significant data. The timing of ileostomy closure should be individualized for each patient. PMID: 29230116 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Outcomes of Patients With Late-Relapse Metastatic Renal Cell Carcinoma Treated With Targeted Therapies: A Single Institution Experience.
Conclusion: Patients with late-relapse mRCC treated with targeted therapy had prolonged survival that compared favorably to historical controls, and metastases in uncommon sites were noted. PMID: 29230117 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Prognostic Factors in Typical and Atypical Pulmonary Carcinoids.
We report the findings of the Ochsner Medical Center/Louisiana State University (LSU) Health Sciences Center neuroendocrine tumor (NET) program. Methods: A database with all patients seen at the Ochsner Medical Center/LSU NET program was queried for patients with bronchopulmonary NET. We included patients who had confirmed pathologic bronchopulmonary carcinoid and who had at least 1 clinic visit. Patients with large or small cell NETs or diffuse idiopathic pulmonary neuroendocrine cell hyperplasia were excluded. Results: A total of 169 patients seen from January 1996 to March 2015 met the inclusion criteria. The me...
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

A Potential Additional Variable to Consider in the Surgical Treatment of Ductal Carcinoma in Situ.
Conclusion: Based on these results, an HER2-positive ductal carcinoma in situ is likely to be larger than an HER2-negative tumor, leading to more frequent use of mastectomy. This finding would explain our poor recruitment to the National Surgical Adjuvant Breast and Bowel Project Protocol B-43 trial. PMID: 29230119 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

The Relationship Between Regional Anesthesia and Cancer: A Metaanalysis.
Conclusion: This metaanalysis shows that RA has no overall survival, recurrence-free survival, or biochemical recurrence-free survival benefit. However, some individual studies have shown significant benefit in terms of cancer recurrence. Further, RA reduces the use of opioids, which has led to some secondary benefits. Further studies are needed to establish the benefits of RA as it relates to cancer. PMID: 29230120 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Leptomeningeal Disease and the Evolving Role of Molecular Targeted Therapy and Immunotherapy.
Conclusion: Targeted molecular therapy and immunotherapy in LMD may provide favorable treatment options. Current literature is lacking in safety, efficacy, and overall response rates from the use of targeted therapy. Research is needed to draw significant conclusions about the most appropriate therapy for patients with LMD. PMID: 29230121 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

The Role of Checkpoint Inhibition in Non-Small Cell Lung Cancer.
Conclusion: Treatment of NSCLC is constantly changing, and new immune checkpoint inhibitors have shown promising results. Clinical trials are examining their use in the adjuvant setting and in combination with other therapies, and these combination therapies have the potential to show even greater benefits and broader applications than the individual drugs themselves. PMID: 29230122 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Molecular Targets in Non-Small Cell Lung Cancer.
Conclusion: Patients with advanced NSCLC should undergo mutational testing to evaluate for actionable mutations. If such a mutation is discovered, targeted therapy should be considered for first-line treatment. PMID: 29230123 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Oncology and Palliative Medicine: Providing Comprehensive Care for Patients With Cancer.
Conclusion: Palliative medicine has a wide-ranging role in the spectrum of comprehensive cancer care-from patient diagnosis to survivorship. The entire multidisciplinary care team has a role in providing palliative care in inpatient and outpatient settings. An effective palliative medicine and oncology collaboration improves patient care and quality of life, has broad research and guideline support, and is cost effective. PMID: 29230124 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Older Patients With Acute Myeloid Leukemia: Treatment Challenges and Future Directions.
Conclusion: Older patients with AML are candidates for and benefit from the entire spectrum of AML therapy, including intense chemotherapy, allogeneic stem cell transplant, and clinical trial participation after thorough patient assessment. Older patients with AML would benefit from increased clinical trial enrollment and early inclusion of palliative medicine. PMID: 29230125 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Endocrine Therapy for Early Breast Cancer: Updated Review.
Conclusion: With the implementation of such therapies resulting in decreased mortality, patients with breast cancer are living longer than ever before. The focus of research is now directed toward the length of treatment and prediction models for recurrence. PMID: 29230126 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Intraarterial Liver-Directed Therapies: The Role of Interventional Oncology.
Conclusion: Interventional oncology and its image-guided intraarterial therapies continue to gain recognition as treatment options for primary and secondary liver cancers. Growing evidence supports their role as a standard of care alongside medical oncology, surgery, and radiation oncology. PMID: 29230127 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Sigmoid Colonic Polyp as Initial Presentation of Metastatic Papillary Renal Cell Carcinoma.
Conclusion: To the best of our knowledge, this patient had a rare case of metastatic papillary renal cell carcinoma that metastasized to the colon and presented as a colon polyp. PMID: 29230128 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Paraneoplastic Cardiac Involvement in Renal Cell Carcinoma With Dermatomyositis Sine Dermatitis.
Conclusion: Cardiac involvement as a paraneoplastic process is a rare entity and can present with elevated troponin as shown in our case. Its underlying mechanism has not been clearly elucidated, but this case may shed some light on a new or unknown myocardial manifestation related to malignancy. PMID: 29230129 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Periampullary Carcinoma: Unusual Sites of Metastasis.
Conclusion: Cutaneous and skull metastasis of periampullary neoplasms is unusual, but early recognition of such metastatic disease is important because it indicates a poor prognosis for the patient. PMID: 29230130 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Body Art Confounding a Case of Breast Cancer.
Conclusion: High-density foci in axillary lymph nodes on mammography can be evidence of calcifications or metal deposits and can be the manifestation of a benign or malignant process. Thus, this finding may warrant additional diagnostic workup (including mammography, ultrasound, and possibly biopsy) and correlation with clinical history. PMID: 29230131 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Primary Undifferentiated Pleomorphic Sarcoma of the Penis.
Conclusion: Vigilance regarding biopsy and intervention for penile nodules may lead to early diagnosis and improved clinical outcomes. PMID: 29230132 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Invasive Insular Thyroid Carcinoma Presenting as Nonparalytic Dysphonia.
Conclusion: Physicians should consider the diagnosis of invasive thyroid carcinoma in a dysphonic patient with an infiltrative endolaryngeal process despite intact vocal fold mobility. PMID: 29230133 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - December 14, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

In Their Own Words.
Authors: PMID: 29089862 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - November 3, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

From the Editor's Desk: Well-Being in the Workplace.
Authors: Amedee RG PMID: 29026347 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Positron Emission Tomography-Positive Pleural-Based Nodule Following Talc Pleurodesis.
Authors: Dy R, Patel S, Tunsupon P, Mador MJ PMID: 29026348 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: A Delayed Diagnosis of Iatrogenic Guidewire Retention After Central Line Placement.
Authors: Tunsupon P, Providence AT, Yampikulsakul P PMID: 29026349 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Letter to the Editor: Mobile Technology Can Improve Adherence and Lessen Tacrolimus Variability in Patients Receiving Kidney Transplants.
Authors: Torabi J, Choinski K, Courson A, Zanetti-Yabur A, Rocca JP, Graham JA PMID: 29026350 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Clinical Images: Four-Dimensional Computed Tomography-Future of Preoperative Parathyroid Adenoma Imaging.
Authors: Matthews C, Matthews A, Safavi K PMID: 29026351 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Bioethics in Practice: Dr Alton Ochsner's Ethics.
Authors: Ochsner JL PMID: 29026352 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Association of Body Mass Index and Postoperative Acute Kidney Injury in Patients Undergoing Laparoscopic Surgery.
CONCLUSION: We found a marginal association between BMI and an increased risk of developing AKI in adult patients after having noncardiac laparoscopic surgery. The BMI effect became insignificant when potential mediator variables were considered. The association of BMI and AKI after noncardiac laparoscopic surgery is likely mediated through components of the metabolic syndrome. PMID: 29026353 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Novel Regional Techniques for Total Knee Arthroplasty Promote Reduced Hospital Length of Stay: An Analysis of 106 Patients.
CONCLUSION: This study demonstrated that an IPACK block reduced opioid consumption by providing effective supplemental analgesia following TKA compared to the FNC-only technique. ACB with IPACK provided equivalent analgesia and improved physical therapy performance, allowing earlier hospital discharge. PMID: 29026354 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Colistin and Polymyxin B Minimal Inhibitory Concentrations Determined by Etest Found Unreliable for Gram-Negative Bacilli.
CONCLUSION: We found a high rate of discrepancy between colistin and polymyxin B Etest and broth microdilution MICs. Very major errors (colistin/polymyxin B-susceptible by Etest, colistin/polymyxin B-resistant by broth microdilution) were detected in 10% of isolates tested with colistin and 8% of polymyxin B-tested isolates. The data from this study confirm that broth microdilution should be performed for susceptibility testing of polymyxins. PMID: 29026355 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Comparison of In-Hospital Maternal Mortality Between Hospital Systems in Queensland, Australia and Louisiana, United States.
CONCLUSION: Women from Louisiana, United States and Queensland, Australia have similar rates of preventable maternal death. No statistically significant factors explained trends in Australian maternal death; American maternal mortality was significantly associated with point of entry into prenatal care, likely influenced by insurance status. Furthermore, the majority of deaths in this group were complicated by hospital systems-based factors. PMID: 29026356 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Use of Digital Pupillometry to Measure Sedative Response to Propofol.
CONCLUSION: We speculate that DP may be a useful tool to monitor propofol sedation. PMID: 29026357 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Medicine in Society Health Project: Five Students' Journey to a Resource-Limited Clinic in the Haitian Countryside.
CONCLUSION: Each aspect of the pretrip training was useful but did not prepare the students for the conditions in the poorest country in the Western Hemisphere. Overall, the clinic functioned smoothly, and each student had an important role to play each day. Medicine in Society-Haiti gave the medical students a completely new perspective on medicine as they experienced firsthand the ethical dilemma of resource scarcity. PMID: 29026358 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Innovation and Education Through Simulation at Ochsner.
Authors: Smith M, Tholen CJ PMID: 29026359 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Effects of Tobacco on Health and Disease: Three Decades of the Alton Ochsner Award.
Authors: Frohlich ED PMID: 29026360 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Improving Patient Safety Communication in Residency Programs by Incorporating Patient Safety Discussions Into Rounds.
Discussions Into Rounds. Ochsner J. 2017;17(3):273-276 Authors: Musso MW, Vath RJ, Rabalais LS, Dunbar A, Bolton M, Tynes LL, Hosea S, Johnson AC, Caffery TS, Rhynes VK, Mantzor S, Miller B, Calongne LL Abstract BACKGROUND: Engaging residents in patient safety and quality improvement initiatives is sometimes difficult. The primary goal of the current study was to develop a standardized learning experience designed to facilitate patient safety discussions during rounds. METHODS: Residents who were on inpatient rotations during a 2-month period in 2014 were exposed to patient safety discussions on ro...
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Inflammatory Myofibroblastic Tumor of the Breast Mimicking Malignancy in an Elderly Male.
CONCLUSION: IMT is a rare entity with intermediate clinical behavior. Knowledge of this entity and its recurrence and metastatic potential is of paramount significance to guide appropriate treatment and follow-up. PMID: 29026362 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Highly Accelerated Onset of Hydroxychloroquine Macular Retinopathy.
CONCLUSION: Known major risk factors for HCQ retinal toxicity include drug loads>300 mg/day (5 mg/kg/day), use for>5 years, a cumulative dose>1,000 g, underlying retinal disease or retinopathy, tamoxifen use, and renal disease. Despite not having any of these risk factors and having a reduced drug load during the treatment period, our patient developed the signs and symptoms of HCQ toxicity. This case suggests underlying mechanisms for HCQ toxicity other than those previously reported and a need for additional screening tests to prevent HCQ toxicity. PMID: 29026363 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Recurrent Pneumothoraces in a Patient With Pulmonary Benign Metastasizing Leiomyoma.
CONCLUSION: BML should be considered in women with a history of leiomyomata who develop pneumothoraces resulting from peripheral pulmonary nodules. A standardized treatment regimen has yet to be established, and therapy plans require a multidisciplinary approach, involving gynecology, cardiothoracic surgery, and pulmonology. PMID: 29026364 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Incidental Finding of Bronchopulmonary Sequestration in a 64-Year-Old Female.
CONCLUSION: Pulmonary sequestration can present with recurrent pneumonia in late adulthood. Physicians must review any previous imaging studies of the chest to identify the structural abnormality and be cognizant of differential diagnoses such as infected cystic bronchiectasis, bronchogenic cyst, congenital diaphragmatic hernia, or cystic adenomatoid malformation that can occur in conjunction with bronchopulmonary sequestration. Pulmonary angiogram is the gold standard to confirm the diagnosis of bronchopulmonary sequestration. Surgical resection is the standard of care. PMID: 29026365 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Trigeminal Trophic Syndrome Associated With the Use of Synthetic Marijuana.
CONCLUSION: To our knowledge, the association of disorders of the trigeminal nerve pathway, including TTS, with the use of synthetic marijuana has not been previously reported. The long-term neurologic effects of synthetic marijuana are difficult to predict, and the pathologic underpinnings of TTS are largely unknown. Further studies dedicated to exploring the underlying molecular and cellular mechanisms may translate into effective therapies and approaches to halt and reverse the process and prevent tissue destruction and cosmetic disfigurement. PMID: 29026366 [PubMed] (Source: Ochsner Journal)
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research

Mitochondrial Encephalomyopathy With Lactic Acidosis and Stroke-Like Episodes-MELAS Syndrome.
CONCLUSION: This case is a classic example of the relapse-remitting MELAS syndrome progression with episodic clinical flares and fluctuating patterns of stroke-like lesions on imaging. MELAS is an important diagnostic consideration when neuroimaging reveals a pattern of disappearing and relapsing cortical brain lesions that may occur in different areas of the brain and are not necessarily limited to discrete vascular territories. Future studies should investigate disease mechanisms at the cellular level and the value of advanced magnetic resonance imaging techniques for a targeted approach to therapy. PMID: 29026367 [P...
Source: Ochsner Journal - October 17, 2017 Category: General Medicine Tags: Ochsner J Source Type: research